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The Secretary, PO Box 20 295, Bishopdale, Christchurch, 8543

I/we hereby apply for FBNZ membership - name(s):







              _____________________________________   P.Code: ________

Phone:_____________________________ Mob:_______________________


Accompanying Children:-

1:__________________________ DoB:____/____/____

2:__________________________ DoB:____/____/____

3:__________________________ DoB:____/____/____

4:__________________________ DoB:____/____/____

Date of birth: Applicant:____/____/____ Partner:____/____/____

How would you prefer the newsletter to be sent?  Email____ Post____  (tick one)


Do you wish to be included in the 'Contact List'?      Yes____   No____  (tick one)

(The Contact List is only available to those listed in it.)

Are you a current member of a Naturist Club?         Yes____   No____  (tick one)

If 'Yes', please specify each of them: ______________________________________

Would you like the gonatural magazine advised of your interest in a subscription?

(To have an application form sent, tick: Yes.)  Yes____   No____  (tick one)

The year's subscription of $35 ___ (single) $40 ___ (couple) is enclosed. (tick one)

The subscription was paid to KiwiBank: 38-9014-0140590-00 on: (Date:___/___/___)

How, where or from whom; did you find out about Free Beaches NZ? ____________ 

(If you were referred by a member, who was it, please?)

Apart from the items in the Contact List, the information supplied on this form will
only be available to Officers of the Club's Committee.
You may request that it be changed at any time.

Please read next section before signing.

Signature Applicant:__________________________ Date:____/____/____

Signature Partner:____________________________ Date:____/____/____

Privacy Act 1993

In accordance with Information Privacy Principle 3 of the Privacy Act 1993,
the purposes of the information supplied on this Application Form are:-


Full Name(s)


Date of Birth


Home Phone Number

Children & DoB

Date of Birth

Club Membership

Discovered FBNZ via

To identify the applicant. Your name shows on the ID card.

Required by the Incorporated Societies Act 1908 & helps with organising events

For keeping generic statistics (never individaully disclosed).

To post the newsletter, etc (and an Act requirement).

To communicate with the applicant for activities.

To help plan family activities.

For statistical purposes.

For assistance with New Zealand Naturist Federation liaison.

For research on the source of our members; and/or a reference.